Design

Setting

Participants

In a 6 year period, 127 newborn infants were readmitted to hospital because of hyperbilirubinaemia within 14 days of discharge
from the well baby nursery. Control participants were 127 infants discharged in the same year who were not readmitted.

Commentary

The consequences of early discharge of new mothers and their infants are complex. Shorter maternity stays are now common because
of consumer demand to demedicalise birth and to reduce medical costs.1 Follow up in the community is piecemeal depending on the jurisdiction of practice. It is for this reason that the results
of the study by Maisels and Kring must be reviewed by practitioners with an understanding of their own practice.

Concern has led to retrospective chart review studies to ascertain the relative risk of readmission of newborn infants. Jaundice
has consistently been the primary diagnosis for readmission.2, 3 Although legislation in the US may prevent further reductions in length of maternity stays, the primary issue for healthcare
providers is identifying the infants most at risk and taking appropriate action. Identification of infants at risk (ie, infants
<37 wk gestation, jaundiced before discharge, and breast fed) allows healthcare professionals to direct follow up in the community.
One cannot overstate the importance of timely intervention in hospital to ensure that breast feeding methods are appropriate
and that adequate information about child care is provided.

The design of the study was appropriate to assess the risk of readmission. Case and control infants were matched and all readmissions
were included in the study. The authors acknowledged that retrospective studies rely on accurate data collection and missing
data can be a problem. In jurisdictions where all infants are visited regularly in the community during their first few days
of life, the study serves as a reminder to providers to assess the infants most at risk from early discharge. For practitioners
who work in areas where postnatal visits are not routine, it is important to refer families to suitable follow up care.